Antisocial Personality Disorder Debashree Sinha Antisocial personality disorder

Antisocial Personality Disorder Debashree Sinha

Antisocial personality disorder describes an ingrained pattern of behaviour in which individuals consistently disregard and violate the rights of others around them. The disorder is best understood within the context of the broader category of personality disorders. A personality disorder is an enduring pattern of personal experience and behaviour that deviates noticeably from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to personal distress or impairment.

The symptoms of antisocial personality disorder can vary in severity. The more egregious, harmful, or dangerous behaviour patterns are referred to as sociopathic or psychopathic. There has been much debate as to the distinction between the two descriptions. Sociopathy is chiefly characterized as something severely wrong with one's conscience; psychopathy is characterized as a complete lack of conscience regarding others. Some professionals describe people with this constellation of symptoms as "stone cold" to the rights of others. Consequences of this disorder can include imprisonment, drug abuse, and alcoholism.

• • • Signs of antisocial personality disorder A person with antisocial personality disorder may: exploit, manipulate or violate the rights of others lack concern, regret or remorse about other people's distress behave irresponsibly and show disregard for normal social behaviour have difficulty sustaining long-term relationships be unable to control their anger lack guilt, or not learn from their mistakes blame others for problems in their lives repeatedly break the law Lie, con, and exploit others

• Act rashly • Be irritable and aggressive • Fight or assault other people • Not care about the safety of others or themselves • Fail to meet money, work, or social duties • Abuse drugs or alcohol A person with antisocial personality disorder will have a history of conduct disorder during childhood, such as truancy (not going to school), delinquency (for example, committing crimes or substance misuse), and other disruptive and aggressive behaviours.

Symptoms of antisocial personality disorder According to the DSM-5, features of antisocial personality disorder include: • Violation of the physical or emotional rights of others • Lack of stability in job and home life • Irritability and aggression • Lack of remorse • Consistent irresponsibility • Recklessness, impulsivity • Deceitfulness • A childhood diagnosis (or symptoms consistent with) conduct disorder

Diagnosing antisocial personality disorder The diagnosis of antisocial personality disorder is not given to individuals under the age of 18 but is given only if there is a history of some symptoms of conduct disorder before age 15. Antisocial personality disorder is much more common in males than in females. The highest prevalence of antisocial personality disorder is found among males who abuse alcohol or drugs or who are in prisons or other forensic settings. Antisocial personality disorder is diagnosed after rigorous psychological assessment.

A diagnosis can only be made if the person is aged 18 years or older and at least 3 of the following criteria apply: • repeatedly breaking the law • repeatedly being deceitful • being impulsive or incapable of planning ahead • being irritable and aggressive • having a reckless disregard for their safety or the safety of others • being consistently irresponsible • lack of remorse

Causes • Researchers believe that genetics plays some role, as having a parent with the disorder puts one more at risk. Research on adopted children of parents with the disorder indicates that environment may also be a factor, such as when children receive poor discipline, have negative role models, or are not taught to respect the rights of others. Children of an alcoholic parent are also at increased risk. • Children who have conduct disorder or attentiondeficit/hyperactivity disorder before age 10 are at increased risk for having antisocial personality disorder as adults. This is particularly true for children with conduct disorder who are abused or neglected. Researchers estimate that 25% of girls and 40% of boys with conduct disorder will have antisocial personality disorder as adults.

Treatments Antisocial personality disorder is one of the most difficult personality disorders to treat. Individuals rarely seek treatment on their own and may initiate therapy only when mandated to do so by a court. There is no clearly indicated treatment for antisocial personality disorder. Recently, the antipsychotic medication clozapine has shown promising results in improving symptoms among men with antisocial personality disorder. Treatment for antisocial personality disorder may prove challenging. Because the symptoms of the disorder ten to peak in a person’s early 20 s, people may find that symptoms improve on their own as a person reaches their 40 s and beyond.

Psychotherapy, or talk therapy, is usually the treatment recommended for antisocial personality disorder. A therapist can help a person manage negative behaviours and build interpersonal skills they may lack. Often the first goal is simply to reduce impulsive behaviours that can lead to arrest or physical harm. Family therapy might be a useful option to educate family members and improve communication, and group therapy may also help when limited to people with the disorder.

Treatment should also address any co-occurring disorders, which often include attentiondeficit/hyperactivity disorder, borderline personality disorder, and impulse control disorders such as gambling disorder or sexual disorders. Because a majority of people with antisocial personality disorder will also have a substance abuse disorder, a person may need to complete detoxification as the first step of treatment, with the substance abuse and personality disorder then treated simultaneously. Besides these Democratic therapeutic communities can also be useful to treat antisocial personality disorder.

Democratic therapeutic communities (DTC) Evidence suggests community-based programmes can be an effective long-term treatment method for people with antisocial personality disorder, and is becoming increasingly popular in prisons. DTC is a type of social therapy that aims to address the person's risk of offending, as well as their emotional and psychological needs. It's based around large and small therapy groups and focuses on community issues, creating an environment where both staff and prisoners contribute to the decisions of the community. There may also be opportunities for educational and vocational work. The recommended length of treatment is 18 months, as there needs to be enough time for a person to make changes and put new skills into practice.

Self-motivation is another important factor for acceptance on to this type of scheme. For example, the person must be willing to work as part of a community, participate in groups, and be subject to the democratic process. The Ministry of Justice has more information about DTC in their guide to working with offenders with personality disorder.

Medication There's little evidence to support the use of medication for treating antisocial personality disorder, although certain antipsychotic and antidepressant medications may be helpful in some instances. Carbamazepine and lithium may help control symptoms such as aggression and impulsive behaviour, and a class of antidepressant called selective serotonin reuptake inhibitors (SSRIs) may improve anger and general personality disorder symptoms.